Non-Operative Management of Cholecystitis in Pregnant Patients Remains Common

Background: Cholecystectomy is the recommended treatment for acute cholecystitis in pregnancy, leading to fewer pregnancy-related complications than non-operative management. However, past research demonstrated high rates of non-operative management despite these recommendations. Rates of cholecystostomy tube usage and outcomes in pregnancy are not well described. We hypothesized that rates of interventions for cholecystitis have increased over time. Patients and Methods: The National Readmissions Database was queried for all visits in the first three quarters of each year 2016 to 2019, which included a patient with an International Classification of Diseases-10 code for cholecystitis and pregnancy. These entries were then further investigated for demographics, gestation, rates of interventions at the index admission (cholecystectomy or cholecystostomy tube), 90-day readmissions, interventions at readmission, and pregnancy-related complications. Results: Annual rates of interventions for cholecystitis remained low over the study period (27.0%-34.9%). Of patients treated with non-operative management, 6.0% had cholecystectomy on readmission. Compared with the first trimester, interventions were more likely in the second trimester (p < 0.001) and less likely in the third trimester (p < 0.001). Length of stay was highest for cholecystostomy tube placement and lowest for patients who received non-operative management. Conclusions: Cholecystectomy rates in pregnancy remain low despite evidence that cholecystectomy is safe. Cholecystostomy appears to be a safe alternative but associated with a longer length of stay. Further study is needed to determine what barriers exist to adequate treatment of cholecystitis in pregnant patients.